The invention concerns a vascular everting tool for use in performing sutureless anastomosis.
Severed blood vessels and other tubular fluid carrying body members requiring anastomosis are frequently encountered in penetrating wounds inflicted during combat, civil violence and automobile accidents. Other surgical procedures requiring anastomosis are the bypassing of blocked tubular members or replacement of a portion of a vessel or other tubular member with a portion of a vessel taken from another part of the body. Still another surgical procedure requiring anastomosis is the replacement of a damaged or diseased vessel or other tubular member with a prosthesis. At the present time, when these types of surgical procedures are necessary and when the requisite skills and facilities are available, the tubular members are anastomosed using a suturing procedure. As can be appreciated, the suturing of blood vessels or other tubular members requires exquisite skill and is a time consuming procedure. Under combat or emergency conditions, the requisite skills, facilities and time may not be available to prevent loss of limb or life.
U.S. Pat. No. 2,940,452 to Smialowski teaches a vascular everter for everting the end of a blood vessel over the end of a bushing, or the like, preparatory to effecting the suturing operation. Smialowski discloses a tubular body having a diaphragm of rubber over one end, a bore of the tubular body being enlarged to form an annular recess. Within the bore is a plunger, which upon manual depression, causes distention of the diaphragm. As pressure on the plunger is progressively released, the body is slowly reciprocated until the bushing enters the annular recess. The instrument is withdrawn leaving the blood vessel end everted on the bushing. In a second embodiment, a lever is used to manipulate the plunger. It is apparent, however, that as the plunger is withdrawn or the body is worked forward, the diaphragm tends to return to its flattened state, allowing the artery end to close to its normal shape. Thus the eversion is prevented and the artery is merely jammed into the annular recess.
U.S. Pat. No. 3,040,748 to Klein et al., shows a vascular positioning method and device, generally similar to the Smialowski device. However, the Klein et al. device includes a suction air pump for drawing a blood vessel through a bushing. A cylinder is moved towards a bushing, which causes a collar to be turned inside out by engagement of an end edge with a flange of the collar. This action everts the overlying portion of the blood vessel. Obviously, the requirement of a pressure-creating device (the suction air pump) makes the Klein et al everter awkward to manipulate.
In U.S. Pat. No. 4,470,415 to Wozniak, an everting tool is disclosed having a head portion with rotatable and stationary sections. Wire arms are mounted to the rotatable section and are guided by staples attached to the stationary portion. Upon actuation of a shaft, a gear drives the rotating portion relative to the stationary portion, such that arms open to flare an artery end. Also included is a balloon mechanism, used to pull the artery through the flared end. In this design endothelial cell damage conceivably may occur due to the pressure and movement of the balloon within the vessel lumen. Blood flow over damaged endothelial cells of the vessel may cause clotting, restricting blood flow, and defeating the purpose of anastomosis. The device disclosed in the Wozniak patent is used in sutureless end-to-end anastomosis, to join artery ends, for example.